Sensory wellbeing workshops for inpatient and day-care patients with anorexia nervosa.

BACKGROUND: The wellbeing of patients with eating disorders is one of the priorities in the "bigger picture" of treatment for eating disorders. Sensory soothing strategies for sensory sensitivities are supportive tools which could be useful in day-care and inpatient clinical programmes. METHODS: Evaluation of multiple separate sensory wellbeing workshops consisting of psychoeducation and experiential components delivered in inpatient and intensive day-care services was performed. Participants' self-report questionnaires were evaluated pre- and post-workshop. Additionally, patients' comments and qualitative feedback was collected after completion of the workshop. RESULTS: There was strong evidence that self-reported awareness of sensory wellbeing, awareness of strategies to enhance sensory wellbeing, and confidence in managing sensory wellbeing increased after the workshops with positive qualitative feedback from participants. The feedback questionnaires highlighted that patients found the sessions useful and were able to use some of the skills and strategies they learned in the workshop. CONCLUSION: This pilot work on sensory wellbeing workshops with a protocol-based format was feasible and beneficial for the patient group. Preliminary evidence suggests that delivery of similar workshops could be sensible in addition to treatment as usual in inpatient and day-care programmes.

Factores fisiopatológicos y metas terapéuticas perioperatorias que influyen en procedimientos quirúrgicos reconstructivos mediante colgajos en pacientes con Diabetes Mellitus / Pathophysiologic factors and perioperative therapeutic goals that affect reconstructive surgical procedures with flaps in patients with Diabetes Mellitus

RESUMEN Introducción: la diabetes mellitus es considerada un factor de riesgo para complicaciones locales y fracaso quirúrgico en cirugías reconstructivas mediante el uso de colgajos debido a las alteraciones en el proceso de cicatrización propias de esta patología. Objetivo: hacer una revisión de la literatura disponible sobre los factores fisiopatológicos que influyen en los resultados posquirúrgicos a corto, mediano y largo plazo en la población diabética, así como de las metas terapéuticas perioperatorias asociadas a mayores tasas de éxito. Metodología de Búsqueda: se realizó búsqueda en las bases de datos PUBMED, MEDLINE Y SCIELO, mediante el gestor de búsqueda utilizando los términos: "Period perioperative", "Reconstructive surgical procedures", "Surgical flaps", "Diabetes mellitus", obteniendo un total de 160 artículos de revistas en línea, de los cuales se seleccionaron 50. Resultados: la realización de colgajos en pacientes con diabetes mellitus se asocia a mayor riesgo de fracaso y complicaciones, las cuales disminuyen considerablemente si se realiza un estricto manejo perioperatorio enfocado en metas. Conclusiones: la diabetes mellitus causa alteraciones en la respuesta inflamatoria, disfunción microvascular y mayor estrés oxidativo, lo cual se ve reflejado en un proceso de cicatrizacion anormal, generando mayores tasas de infeccion y perdidas de colgajos; un estricto manejo peri operatorio guiado por metas logra disminuir las complicaciones y aumentar el exito quirurgico. MÉD.UIS. 2017;30(1):35-43.

ABSTRACT Introduction: diabetes mellitus is considered a risk factor for local complications and surgical failure in reconstructive surgeries, mainly in flaps due to the fact that it causes alterations in the cicatrization process. Objective: to review the available literature on the pathophysiological factors that influence the short-, medium- and long-term results in the diabetic population, the perioperative therapeutic goals associated with higher success rates, and to establish a baseline protocol for the perioperative management of these patients. Searching methodology: we searched the PUBMED, MEDLINE and SCIELO databases using the search terms "Period perioperative", "Reconstructive surgical procedures", "Surgical flaps", "Diabetes mellitus", obtaining a total of 160 online journal articles, of which 50 were selected. Results: the performance of flaps in patients with diabetes mellitus is associated with an increased risk of failure and complications, which decrease considerably when a strict goal-directed perioperative management is performed. Conclusions: diabetes mellitus causes alterations in the inflammatory response, microvascular dysfunction and increases oxidative stress, which is reflected in an abnormal healing process, generating higher infection rates and graft loss, but if glycemic management goals are achieved in the perioperative period it is possible to reduce the complications and to increase the surgical success. MÉD.UIS. 2017;30(1):35-43.

Adenoma hipofisario productor de TSH (tirotropinoma): presentación de cinco casos / TSH Secreting Pituitary Adenoma (Thyrotropinoma): Five Case Reports

El tirotropinoma es el adenoma hipofisario menos frecuente (< 2 %). Debido a su infrecuencia, describimos 5 casos. Caso 1: Varón de 23 años, presentó fibrilación auricular aguda. El perfil tiroideo mostró: TSH: 4,2 uUI/ml (0,3-4), T4: 14,8 ug/dl (4,5-12,5), T4L: 2,2 ng/dl (0,8-1,9),T3: 170 ng/dl (80-180), T3L: 7,8 pg/ml (1,8-4,6) y test de TRH-TSH plano. La resonancia nuclear magnética (RNM) de cerebro reveló un macroadenoma. Se inició tratamiento con metimazol sin lograr respuesta apropiada. Luego comenzó tratamiento con octreótido-Lar logrando el eutiroidismo. Fue intervenido por vía transesfenoidal (TE), confirmándose por inmunohistoquímica (IHQ) adenoma (+) para TSH. A los 7 días luego de la cirugía la TSH se constató suprimida. Cinco años después se encuentra en remisión. Caso 2: Mujer de 41 años, consultó por hipertiroidismo bioquímico e hipertensión arterial (HTA). La evaluación hormonal mostró: TSH: 3,21 uUI/ml (0,4-4), T4: 16,9 ug/dl (4,5-10,9), T4L: 2,2 ng/dl (0,8-1,5), T3: 245 ng/dl (60-180) y test de TRH-TSH plano. La RNM evidenció un microadenoma de 2 mm. La terapia con cabergolina no modificó las hormonas tiroideas. El tumor mostró crecimiento progresivo (10,8 mm a los 2 años). Se operó por vía TE y el tumor fue (+) en la IHQ para TSH y GH. Luego de la cirugía presentó TSH suprimida por 15 días. Actualmente lleva un año y medio libre de enfermedad. Caso 3: Hombre de 53 años consultó por disminución de la libido, impotencia sexual y aumento de peso. El laboratorio reveló: TSH: 9,1 uUI/ml, T4L: 1,79 ng/dl (0,9-1,8), T3: 164 ng/dl (40-181). En la RNM se halló un macroadenoma. Se realizó cirugía TE, el adenoma fue (+) para TSH y GH en la IHQ. Evolucionó con hipotiroidismo primario. Caso 4: Mujer de 36 años consultó por hipertiroidismo. El perfil tiroideo reveló: TSH: 3,76 uUI/ml (0,4-4), T4: 13,2 ug/dl (4-12), T4L: 2,3 ng/dl (0,9-1,7), T3: 247 ng/dl (70-200) y test TRH-TSH plano. La RNM evidenció un adenoma de 10 mm. Se intervino ...

Thyrotropinomas are the less frequent adenomas (< 2 %). Because of their infrequency, we report 5 cases. Case 1: 23-year-old man, with sudden atrial fibrillation. The hormonal profile showed: TSH: 4.2 uIU/ml (0.3-4), T4: 14.8 ug/dl (4.5-12.5), FT4: 2.2 ng/dl (0.8-1.9), T3: 170 ng/dl (80-180), FT3: 7.8 pg/ml (1.8-4.6) and flat TRH test. MRI revealed a macroadenoma. Therapy with metimazol was initiated, without response. Subsequently, treatment with octreotide-Lar was started and euthyroidism was reached. He underwent transsphenoidal surgery. Immunohistochemistry was positive for TSH. One week after surgery, TSH was suppressed. He has been free of disease for the last 5 years. Case 2: 41-year-old woman with biochemical hyperthyroidism and hypertension. Labs showed: TSH: 3.21 uIU/ml (0.4-4), T4: 16.9 ug/dl (4.5-10.9), FT4: 2.2 ng/dl (0.8-1.5), T3: 245 ng/dl (60-180) and flat TRH test. On MRI a microadenoma of 2 mm was diagnosed. Therapy with cabergoline did not normalize thyroid hormones. The tumor grew to 10.8 mm after 2 years. Transsphenoidal surgery was performed. Immunohistochemical staining was positive for TSH and GH. She evolved with suppressed TSH for 15 days. She has been free of disease for the last 18 months. Case 3: 53-year-old man, with loss of libido, sexual impotence and weight gain. Laboratory tests revealed: TSH: 9.1 uIU/ml, FT4: 1.79 ng/dl (0.9-1.8), T3: 164 ng/dl (40-181). MRI showed a macroadenoma. Trans­sphenoidal surgery was performed, the adenoma was positive for TSH and GH. The patient evolved with primary hypothyroidism. Case 4: 36-year-old woman who presented with hyperthyroidism. The thyroid profile revealed: TSH: 3.76 uIU/ml (0.4-4), T4: 13.2 ug/dl (4-12), FT4: 2.3 ng/dl (0.9-1.7), T3: 247 ng/dl (70-200) and TRH test was flat. MRI showed an adenoma of 10 mm. She underwent transsphenoidal surgery. Immunohistochemical staining was positive for TSH and GH. She evolved with suppressed TSH for 15 days. She has been free of disease for the last 8 years. Case 5: 49-year-old man, with decreased libido and occasional headaches. The hormonal evaluation revealed: TSH: 14.4 uIU/ml (0.3-4.9), T4: 14.8 ug/dl (4.5-12), T4L: 4.1 ng/dl (0.8-1.5). On MRI an invasive macroadenoma was found. Therapy with octreotide-Lar was started and he was lost to follow-up. Conclusions: We report these cases because of their low prevalence. We emphasize that clinical presentation was variable. We can speculate on the secretion of a less biologically active TSH for cases with no symptoms of hyperthyroidism. Five out of five (5/5) showed non-suppressed TSH, 3/5 presented a macrodenoma at ini­tial diagnosis, 3/5 showed TSH suppression one week after surgery, which might be considered as a criteria of cure. Four out of four patients operated on were cured. Rev Argent Endocrinol Metab 51:141-150, 2014 No financial conflicts of interest exist.

[Clinical and epidemiologic characteristics of acute diarrhea in adults at a hospital from Cordoba city]. / Caracteristicas clinico-epidemiologicas de la diarrea aguda del adulto en un hospital de la ciudad de Cordoba.

The purpose of this work was to assess the clinical and epidemiologic presentation features of adult acute diarrhea in a general hospital form Córdoba City. All the patients older than 14 years old who assisted to the Hospital Nacional de Clínicas Central Guard for acute diarrhea, during the periods: A (15-12-89 to 15-03-90), B (15-12-93 to 15-03-94) and C (15-12-94 to 15-03-95), were included. 594 patients were studied: 337 female (56.7%) and 257 male, 143 in the period A, 250 in B and 201 in C. The means +/- SD age was 34.6 +/- 13.3 and stool loose per day at admission 7.3 +/- 4.7. Eighty six percent of patients presented liquid consistent stool, 89.6% abdominal pain, 44.7% vomiting and 18.8% bloody stools. The rate of patients who consulted Central Guard referring acute diarrhea increased from period A (2.4%) to B (3.61%); p = 0.002 and decreased form B to C (2.85%); p = 0.01. The mean (+/- SD) days transcurred from the beginning of diarrhea episode till consultation was 3.5 +/- 2.7; 2.7 +/- 2.3 y 2.9 +/- 3.5 in the periods A, B and C respectively, statistically significant difference between A and B, p < 0.01. Thirty six percent, 21.1% and 23.1% of patients presented mucus with their stools in the periods A, B and C (p = 0.01), and high temperature 61.1%, 48.1% and 48.5% respectively (p = 0.04). Twenty seven percent of stools samples cultures became positive in the periods A, 17.6% in B and 11.5% in C, statistically significant difference between A and C; p = 0.008. The results show that in a general hospital from Córdoba City the adult acute diarrhea is a frequent cause of consult. In the last years there were modifications in its clinical an epidemiologic presentation features.